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The aides are coming daily as mom is remaining in bed and so it appears incontinent when not that long ago although she had a few accidents, she was able to get to the bathroom and if not messed herself and clothing up. Incontinent x 2. So clearly the aides assistance is a blessing. However mom has enough spunk to be sensitive and object to being cleaned up "down there". Her phrases are typically "THAT'S ENOUGH" or "GET OUT OF THERE". Completely understandable. But today as I stood by holding the bag for soiled disposables, Mom was basically lying naked on the bed the aides having removed her gown. Thinking she was chilly or could at least have a bit of coverage I placed the gown over her private area, which brought a comment from the aide that they had gotten it away from her and I basically gave it back (ie. complicating their job). My question is what is SOP? I believe I've read, and experienced myself when in the hospital in the past year, that care should be taken to protect the patient's privacy and to keep them comfortable...i.e. the areas not being cleaned at the time should be kept covered. It's hurtful to think they might make their job easier by taking advantage of someone with dementia, but considering the agency I can't imagine they were not trained correctly. Would you say something to them or a supervisory person?

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My mom just moved into the same bedridden situation a few weeks ago. She objects to the weekly bathing mostly because the wipes are cold & she’s very private. The quicker it’s done, the better. I find warm sudsy wash rags are more efficient, comfortable & quicker than all the small wipes. Hospice bathes her weekly & visits 5x a week helping with brief changes. Regarding the hospice employee who criticized you for covering her. This is a sensitive time for you & your mom. Hospice is there overall to provide comfort for the patient & family. If you know your mom needs covered, tell them she will do better if they keep her covered most of the time, then you do it for her. I had 2 different hospice employees that were not positive for my mother. 1 was loud & pushy, the other berated me over my mom while we were changing her & everything was still very new to me as I was trying to learn. My mom’s comfort, the peace & harmony in the house & positivity come first & foremost for the optimal best loving environment during this time. I won’t tolerate negativity while I’m doing my best. I talked to the hospice manager on both occasions & was given new employees to come out. I could seem picky but when I feel good about who’s coming through the door & my mom & are aren’t tensing up from overbearing people with a predisposed attitude, we are much calmer & mom is way more comfortable in the TLC hands of good people who are kind & caring. Do what’s best for your mom & don’t care what anyone else thinks about that. ❤️😊
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gdaughter Jun 19, 2021
Thank you! That is so helpful. I am trying to be thoughtful and compassionate toward all, but really need to keep mom, and our family at the top of the list. Also note that while the sudsy rags are more efficient for your circumstances, in our case there is solid or soft poo to be removed and so that complicates things and the wipes are better being disposable and not needing to be rinsed out or replaced. We'd go through so many of them and I would wind up with even more laundry, stinky and time consuming to rinse out prior at that...Your final line says it all...thanks again.
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The Hospice CNA that was assigned was extremely cautious of exposing my Husband.
Taking him from the bedroom to the bathroom she made sure he was covered.
When bed bath became necessary she would expose only the part of his body that she was washing at the time. She would wash, rinse, dry and cover then move to another part of the body.
If the aides are not following this type of process you can say something. If they ignore your request you can call Hospice and and talk to a supervisor or Care Manager.
If your request is still ignored I would contact another Hospice agency as this is one I would not want caring for my loved one.
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gdaughter Jun 19, 2021
Gram nails it again! Bless you....as mentioned in a response prior, I hope to address the issue with the aides on their return Monday. If they cannot or will not follow the protocol you described which is how others have made clear is the correct way, I will take immediate action. First to their supervisory person, and then switching agencies as needed.
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Use towels, and plenty of 'em. Any areas not in the process of being cleaned should be covered. Basic.

The aides ought to have done that anyway, without being told, as soon as they removed your mother's gown; so I have a slight red mist forming at the thought that they actively resented your covering her (though I wouldn't have used her gown, myself).

What to do... since you didn't deck them at the time, very restrained of you... put it in writing to their service manager, subject heading "respecting privacy and dignity during personal care." Indeed this ought to have been covered in their training. Perhaps they need a reminder.

Just to underline the importance and versatility of towels: I did a 2:1 round with a male colleague which included a call to a lady bedbound after a stroke. The client was friendly and welcoming, but when it came to changing her pad she called out to her son and said to him: "you know what I want to tell them, don't you?" She was both too embarrassed to have a male helping her, and too afraid to tell us herself directly.* But she's a 2:1 client for a reason - no moving and handling training is going to make it possible for 1 female to turn and wash her - so we reassured her with a compromise. Bath sheet over her, both of us helped her to roll, male worker held her in position, female worker made a sort of tent and did the care. Blushes spared, client happy, and equal opportunities rule!

*Another red flag for me. I seem to spend half my time encouraging people to give feedback and express their needs freely - how else can we get things right? - and it makes me very tight-lipped when they're afraid to. What's been going on?
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gdaughter Jun 19, 2021
Thank you. All the wiseness on this forum is such a blessing to me at this time, especially knowing so many of you have been through it and/or have nursing backgrounds. In fact, today being a weekend day we had an aide who only works weekends and seems to care a bit more. No doubt impacted by the love she has for her grandmother and care she helps provide for her similarly. I asked her opinion and she agreed that the person should be covered appropriately. I grabbed the gown as it was handiest and going to be thrown in the wash. But yes, agree, a towel would have been better. Will look for some smaller bath towels in the closet tomorrow. Bless you for noting my restraint:-) and appreciating it.
I think their service manager may in effect be the nurse on the team. Take note that while I realize it may come from a place of compassion, I have also heard one or the other of these two aides refer to mom as "honey" which I know is nit picky of me to be offended by, but I also do a cursory orientation and review with new employees who serve community residents with light housekeeping, and in fact give them an article about using such cute terms without consent and how demeaning it can be. I would in fact want people to inform me as a supervisor of anything that didn't seem to be going right for the very reasons you mention, but I guess when it is our own circumstances, we are not thinking as clearly....In the end doing the right thing, the right way I would hope makes things far easier for all, as you mentioned in your example! Thanks again...
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Those aides working for your mom are slacking off on the proper bed-bath procedure. This happens sometimes with homecare because it's a more relaxed environment then a nursing home or hospital.
The client's privacy must always be respected when giving a bed bath. That means after their clothes are removed a draw sheet or large towel is used to cover them. The only parts of the client's body that are supposed to be exposed at any time are the ones being bathed. There's no excuse for an aide to slack off the way your mom's are.
Talk to them ONCE about it. Let them know that if they slack off like that again or treat your mom with such indignity, they will be fired at once. Also, let them know you will get them in trouble with their agency. You do not allow them to criticize you for telling them something. Oh no, I don't think so.
There's no excuse to justify slacking off like that and I'm sorry your mom got treated like that. Caregivers like hers give all of us a bad name.
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gdaughter Jun 22, 2021
Not only more relaxed environment, but awareness they are probably dealing with clueless and overwhelmed family who will not report the behavior because they are so grateful. As I mentioned prior, I did speak to the supervisor as I don't need to take on any further stress to protect my own well being, and the nurse in charge of them seemed to impact things as they seemed improved yesterday. But I will be on alert to maker sure it continues. Also aware I do not have the authority or right to fire them, and don't intend to threaten as I know as an agency it is very hard to find reliable employees...but certainly their supervisor could provide re-training and do visits that coincide with care to observe and make sure it's being done correctly. Thanks for your support and compassion. Much appreciated:-)
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I'd stay by her head, hold her hand, and placate mom (as you would a child) with a soothing, running dialog of: "It's just us girls here, mom, and it will be over soon. They're almost finished! Won't it feel good to be clean again?" The aides are doing their job and it doesn't sound like abuse to me. But I'm biased, because if hospice aides came to bathe my mom every day instead of once a week, I'd be handing out gifts.
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gdaughter Jun 22, 2021
This is what hospice service is, to provide what the homebound patient needs, so if she needs cleaning daily due to incontinence, so be it. Yes, I am grateful, but I don't also lose sight of the fact that they have signed on for the job knowing what it involved. I have also tried the lines or similar you mentioned, but my mother is hellbent on being unpleasant and that is a reflection of her life-long personality. Note also they do not do a full bath if it is not necessary and only clean the areas in need.
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First I have to say WOW!!! You actually get to have hospice aides come every day to help clean up your mom? I honestly have NEVER heard of that in all my dealings with hospice. You are lucky for sure.
In my husbands 22 month stint with hospice, they only came twice a week to bathe him, and not at all during the 5 months when Covid first appeared.
But that being said, they should be covering your mom with bath towels while they're cleaning her up, if not for her privacies sake, then to keep her somewhat warm. My husband was very particular on how he wanted to be bathed, and so I made sure I let the aides know, as most often we had different aides weekly. With my husband it was more of a "being cold" issue as he was very cold natured, so they learned to keep his top half covered with one towel and his bottom half with another.
Don't be afraid to speak up. You now have to be your moms advocate. Hospice is there to serve you and your mom, so make sure they are doing things the way you both prefer.
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gdaughter Jun 19, 2021
Thanks FG, will get hopefully plenty of sleep and nutrition tomorrow to brace myself for my assertiveness come Monday. I will try to deal with it with the aides prior to moving up the ladder so to speak. And I will be grateful, though I still am working on finding out what we really are entitled to, that we do have aides every day. But if they take into consideration the family available and their health and limitations, this IS what they should be doing.
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Privacy should be important. There comment that they finally got it from her demonstrates that she told them of her preference. That is how I would address it. They need to work within her preferences.
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You're well within your rights to ask for clarity from the aides or their supervisor.
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Gdaughter, from everything you've reported here, you need a new hospice organization.
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gdaughter Jun 19, 2021
BB, as stated, taking a deep breath and will do so if I don't get the answers and responses I'm getting. Unfortunately it's quite the game in our town, and I learned that of the two major competing hospital systems (disgusting state of affairs that is...that hospital systems even should be in competition so to speak!) one of them doesn't have a hospice system to call their own,they actually work collaboratively with the one we ARE using...which I hoped would make things easier being that mom's neurologist whom I hand picked and is a compassionate guy (currently on leave) is affiliated with this particular hospital system...but we'll see...step one is getting clear on what mom is entitled to and what they are supposed to provide.
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I don't think at this point a new Hospice agency is needed. This same question was asked not long ago. Maybe aides are being trained this way. Maybe its inexperience. I would first ask that they cover Mom as much as possible. My Mom became modest as her Dementia progressed. Also, they feel the cold more. If they object or you get that look "who is the aide here". Then call the supervisor and ask what is the protocol when bathing a client. If as you describe leaving them totally naked, then I would call another agency asking them their protocol. If they cover, then change Hospice agencies.
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